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General NPI Number Information
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NPI Number | 1558866749
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Entity Type | Organization
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Legal Business Name | 9 CROWS ACUPUNCTURE & CHINESE MEDICINE, LLC
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Dates
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Enumeration Date | 03/28/2018
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Last Update Date | 03/28/2018
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Provider Practice Location Address
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Address Line | 620 WELLINGTON PL STE 1
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City | HOPE
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State | ID
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Zip | 83836-8709
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Country | US
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Telephone | 208-264-0644
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 461
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City | HOPE
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State | ID
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Zip | 83836-0461
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Country | US
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Telephone | 208-264-0644
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | DR. JAMIE DAVIS
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Credential |
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Telephone | 208-264-0644
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 171100000X
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Taxonomy Name | Acupuncturist
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License Number |
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License Number State |
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